Seniors’ care in B.C.: systemic failures
GLACIER MEDIA SPECIAL REPORT | Long-term care in the province
The consistent message from the care home sector to the government is the funding is too low to run many of these care homes sustainably [] MIKE KLASSEN ACTING CEO, BC CARE PROVIDERS
For families with the frailest of seniors in long-term care, the cracks in the system that led to a crisis when COVID-19 hit were not a big surprise.
The virus brought problems into the open, but they had been there all along.
For May Mikhail’s 94-year-old mother Isabelle Mikhail, it started with falls. Isabelle had been in North Vancouver’s Lynn Valley Care Centre a couple of months when she fell in 2014. Another fall soon after sent her to hospital with a massive bruise on her face.
Previously, Isabelle had used a walker.
“And after that, she never really managed the walker again. So she was in a wheelchair, but she continued to fall,” said Mikhail. “She fell numerous times off the toilet. I gave really strict instructions: ‘Please do not leave my mom unattended on the toilet because she will try to get off.’
“They said ‘Yes, yes, we will make very sure.’”
But Isabelle continued to regularly fall off the toilet onto the floor.
Such incidents aren’t an anomaly.
For many years, long-term care has been under-resourced, understaffed and largely hidden from public view, say experts.
“It’s unfortunate it took a pandemic to really wake us up to what we’ve been talking about for the past few decades,” said Habib Chaudhury, professor and chair of Simon Fraser University’s Department of Gerontology.
Dr. Roger Wong, a clinical professor in the Division of Geriatric Medicine at the University of British Columbia (UBC), agrees. “I think what it has done is really revealed some of the systemic issues,” he said.
There are 294 long-term care centres in B.C. with roughly 27,000 publicly-subsidized beds – not counting about 8,747 assisted living and over 19,248 unregulated independent living homes for seniors or those which are strictly privately paid. The average age of residents in long-term care is 85 and over 30% are dependent on staff for basic activities like bathing and getting out of bed. Almost 65% of residents have some form of dementia and 30% have severe cognitive impairment.
Until it affects a family directly, however, long-term care for seniors tends to be out of sight and out of mind.
And while most experts recommend that residents receive over four hours of direct care a day, care homes in B.C. continue to fall below that.
One person who has been sounding the alarm for years is B.C.’s Seniors Advocate Isobel Mackenzie.
The Ministry of Health sets 3.36 hours of care a day as guideline for how much care residents should receive. But Mackenzie found 70% of long-term care homes in the province fail to meet that. For contracted facilities the percentage not meeting guidelines rises to 82%.
Perhaps that’s not surprising. As Mackenzie noted in her 2019 report on long-term care homes “Currently, facilities are funded at levels that may not meet this guideline.”
Contracts covering block funding between care homes and health authorities are complex. But for much of the past two decades, “there has been consistent downward pressure on funding,” said Mike Klassen, acting CEO of BC Care Providers, which represents private care home operators in the province. “The consistent message from the care home sector to the government is the funding is too low to run many of these care homes sustainably.”
Under those circumstances, pressure to find ways to be efficient with labour costs is inevitable.
“If you ask why, that’s a million-dollar question,” said Chaudhury. “It’s a value question .... We’ve done a very poor job in long term care.”
In the case of Mikhail’s elderly mother, caregivers encouraged her to use a diaper rather than a bathroom – describing it as a ‘toilet in her pants’ – not because she was incapable, because they didn’t have time to help her, said her daughter.
“There’s never enough care aides to stay with them long enough,” said Kelly Shellard, whose 82-year-old dad, Bill Shellard, has dementia and is also in care at Lynn Valley Care Centre. “These are people who try really hard to do their best. It’s a really hard job. But it’s an impossible job when there are not enough bodies physically to do it.”
Today’s long-term care system was first developed in the 1960s. But unlike other government health care services, long-term care was never put in the Canada Health Act, meaning there are no national standards.
That’s why long-term care can be very different in different provinces.
In earlier decades, there was also a more tiered approach to seniors’ care in B.C., say experts.
Residents in long-term care home were “much more diverse in terms of their needs,” said Jennifer Baumbusch, a registered nurse and professor at UBC’s School of Nursing, who specializes in residential care.
About 20 years ago, however, that shifted. People being placed into long-term care “had to be fairly complex and dependent to qualify.”
Critics have maintained the move artificially reduced – temporarily – the need for long-term care, while forcing seniors into cheaper assisted living beds.
But while the needs of those in long-term care increased, staffing levels didn’t, said Baumbusch.
Many physical buildings that had been constructed for a more capable population of seniors were also now providing homes for increasingly frail residents.
“If you go to any care home you’ll see long hallways,” where it’s easy for dementia patients to get lost, and dining rooms on main floors that residents have to be brought down to, said Chaudhury. That only adds to the difficulties of providing care.
The other major change that happened in the early 2000s was a move to increased privatization and contracting out of long-term care for seniors – in part because contracting those services was cheaper for government than building and operating new care homes directly.